"Working Out the Kinks: How an Update to the Psychiatric Bible Is Redefining Sexuality and Morality"

This May, the American Psychiatric Association (APA) will publish its first update since 2000; it is the DSM-5—the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. It may not seem like a big deal to the layperson, but the new edit will forever change the definition of kinky sex and is likely to trigger a wave of political, legal, and pharmaceutical debates.

Previously, the DSM defined all "non-normative" sexual behavior (acts not solely focused on the genitals or breasts) as paraphilias (a.k.a. kinks), from foot fetishes to sexual sadists. According to Susan Wright, spokesperson for the advocacy group the National Coalition for Sexual Freedom, the DSM-5 will differentiate between two kinds of kink: that which is happily enjoyed by healthy people who like kinky sex (paraphilias) and that which causes "distress" or "harm" to others (paraphilic disorders).

"The new language will have repercussions in psychiatry, in legal settings, and also in our understanding of what kinky sex is," says Wright, who saw original drafts of the proposed language. She hopes it will validate healthy people who enjoy kinky sex—and set them apart from the mentally ill.

"Kink is sometimes just about a power exchange or role play," she notes. Practitioners of BDSM (bondage, discipline, sadomasochism) and S&M play with intense sensations that cause extreme pleasure, not harm. These are usually consensual acts. "The people who do it nonconsensually," Wright says, "such as sexual sadists and psychopaths, or even someone in the kink community who steps over the line and goes too far, should be arrested."

The ultimate significance of this edition lies in its reach: Not only will the book help psychiatrists diagnose patients, it will also aid judges, lawyers, police, physicians, clinicians, and policy-makers. Misinterpretation by those outside the medical field, however, is a very real possibility, and a big deal, say, if you lose a custody battle, get evicted from your home, lose your job, or are simply reviled because of your sexual predilections. (It's not inconceivable, for example, that a parent's fondness for BDSM could be raised in a family-court child-custody battle and used against him or her as proof of being "unfit" or something.) But the DSM-5's new language, designed to clearly distinguish sexual fetishes from mental illnesses, could obviate these kinds of judgments. Remember: Social stigma around BDSM and kink has resulted in a tremendous amount of discrimination in the past. And the DSM defined homosexuality as deviant until 1973.